Vol. 6, Issue 1, Part A (2024)

Background: Vaginal birth after cesarean section (VBAC) is one of the strategies developed to control the rising rate of cesarean sections (CSs). It is a trial of vaginal delivery in selected cases of a previous CS in a well-equipped hospital.
Aim: The study was conducted to assess the safety and success rate of vaginal birth after CS (VBAC) in selected cases of one previous lower segment C/S.
Materials and Methods: The study was conducted at Tikrit Teaching Hospital from October 2023 to March 2024, involving 3771 pregnant women, with 510 being cesarean sections. Data was collected from various sources, including daily morning report presentations, delivery logbooks, and patient files. Exclusion criteria included women with multiple previous cesarean deliveries, known previous uterine incisions or T-incisions, prior uterine rupture, extensive trans fundal uterine surgery, multiple gestations, and those contraindicated for vaginal delivery. Obstetric variables were standardized for accurate data collection and analysis, including malpresentation, dystocia, and obstetric hemorrhage cases. Accurate documentation was also provided to assess the prevalence and management of these critical obstetric emergencies.
Results: The study revealed that 3771 deliveries, 2163 (57.36%) were conducted through vaginal delivery, while 1608 (42.64%) were delivered via Cesarean section. 
Regarding VBAC, among the 510 cases involving the first cesarean section, 43.53% resulted in successful VBAC, while 56.47% opted for repeat cesarean section, underscoring the varied preferences and outcomes in subsequent deliveries. Factors associated with successful VBAC were identified, with a significant proportion attributed to the presence of a previous vaginal birth before cesarean section (50.90%), previous VBACs (26.13%), and a higher Bishop Score (22.97%), Additionally, various risk factors for another emergency LSCS were delineated, including advanced maternal age (19.44%), obesity (15.63%), gestational diabetes mellitus (14.24%), pre-existing diabetes (11.46%), and other obstetric complications such as chronic/pregnancy-induced hypertension, preeclampsia/eclampsia, fetal distress, cephalopelvic disproportion, malpresentations, oligohydramnios, prolonged PROM, multiple gestation, cervical dystocia, failure of induction, unfavorable cervix, and cord prolapse. The findings indicate a considerable number of women achieved successful VBAC, a substantial portion opted for repeating cesarean section, indicating varied preferences and outcomes in subsequent deliveries.